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Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A
Luis Fuenmayor-González1, Jair Vera-Ormaza2, Hua Shen3
1Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador.
Insights
Older age, obesity, arterial hypertension, and diabetes mellitus significantly increased mortality risk in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19). Invasive mechanical ventilation also correlated with higher mortality rates.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) posed a significant threat to patients requiring intensive care unit (ICU) admission.
- Identifying risk factors for mortality in critically ill COVID-19 patients is crucial for improving outcomes.
Purpose of the Study:
- To assess the impact of patient characteristics, clinical history, laboratory results, and ventilation strategies on ICU survival for COVID-19 patients.
- To identify key risk factors associated with mortality in this vulnerable population.
Main Methods:
- A retrospective, multicenter cohort study involving 991 adult COVID-19 patients admitted to ICUs in Ecuador between March 2020 and December 2021.
- Survival analysis was performed using semi-parametric Cox proportional hazards models to evaluate risk factors.
Main Results:
- The overall ICU mortality rate was 51.1%.
- Significant risk factors for decreased survival included arterial hypertension, diabetes mellitus, age over 62, obesity, higher SOFA scores, low PaO2/FiO2 ratio, and invasive mechanical ventilation.
- Older age, obesity, hypertension, and diabetes were strongly associated with increased mortality.
Conclusions:
- Arterial hypertension, diabetes mellitus, older age, obesity, and the need for invasive mechanical ventilation are critical predictors of mortality in COVID-19 ICU patients.
- Findings highlight the importance of managing comorbidities and optimizing ventilation strategies in critically ill COVID-19 patients.
Abstract:
Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ± 13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.
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